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Friday, August 3, 2012

Staff Health Care Committee: August 2012 Highlights (A MUST READ)

FY14 Health Care Design Plan Considerations

1. Remove the ability to waive coverage (opt out). This would bring about 500 employees back on the plan and recover anywhere between $217,000 - $600,000 in health care charges paid by employees, depending on their plan and dependent enrollment.2. Drop the 500 Plan. There are currently less than 5% of UA employees utilizing the plan.

3. Establish a tier system for families, so families with more children (probably up to 3) would pay more. This would also apply to the employee + child(ren) rate, which currently is the same regardless of how many children are enrolled.4. Develop a new High Deductible Health Plan (HDHP), while maintaining the existing one, that will qualify for a Health Savings Account (HSA). Items to consider:

Any individual that is covered under another medical plan (Military, Alaska Native, etc.) is not eligible to participate in the HSA.

If spouse participates in Flexible Spending Account (FSA), the HSA is not available through UA.

HDHP with HSA in which the plan covers more than the employee, the plan automatically moves to the family deductible.

The funds roll over from year to year.

When employment ends the employee keeps the account.

Monies are only available as they are deposited into the HSA

Employee is solely responsible for ensuring federal guidelines are met.

Staff Health Care Committee (SHCC) meetings are open to all UA staff. The next meeting of SHCC will be held August 28, 2012 at 9:00 am. You may call in at 800-893-8850 and the pin is 4236369. When calling in please put your phone on mute.

You may also provide your feedback, concerns, questions or comments to any SHCC member via email. See committee members and email addresses below.

38 comments:

Anonymous
said...

My wife and I both work for the university. She has opted out and is covered by my policy. If she is not able to opt out it would double, yet again, what we pay for the policy. Please leave us the option of opting out.

The main reason people opt out is either they have a spouse also in the UA system or a spouse in the military. If they are in the military, stopping them from opting out would have a direct effect to the cost UA has to pay. The military requires any other insurance to be primary- no matter the birth dates and also charges UA insurance for any use of military facilities. By requiring those employees to be covered, the University, in effect, would now be charged for military provided care they would not have incurred before.

#1 are, won't we incur more claims for the people who currently opt out? It may generate more premium revenue but I would think there would be a corresponding rise in claims to some degree. Will the benefits/income outweigh the cost?

I support having an HSA option, but don't like some of the points you list (#3 & #6). Don't know how much flexibility there will be in crafting this plan...doesn't the prescription portion have to be included (not separate like it is currently).

NO on "remove ability to opt out" YES on drop the 500 plan (Not saying there isn't one, but I can't think of a really legitimate reason why that 5% of people would be adversely affected by this) YES YES YES YES on establish a tier system for families. I can't believe this hasn't happened already. I am making a personal choice not to have children. While I wholeheartedly support other peoples choice to have a family, I don't feel it is my responsibility to subsidize their health care at my expense. (I don't mean to sound curmudgeonly, I do give back in a plethora of other ways when I can, like volunteering my time to kid-friendly education events, donating to scholarship funds, using my vote to support school bonds etc...) Neutral on the HDHP- I'm still a little confused about the option.

I support removing the $500 plan. I am curious about how much that would save the university given the few amount of people on it.

I would be very interested in having an HDHP that qualifies for an HSA. It's not an option that I think I would personally use, but I think it's a really good and valid option for those in good health and/or have secondary insurance.

I don't understand how not letting already covered employees decline coverage would help. If they're not on the plan, does the university still pay for them? And maybe they would pay premiums, but would the premiums they pay compensate for their usage?

At one time the committe was looking at using Centers of Excellance for certain conditions where the in state charges are 50 to 80% higher than, this would allow employees to travel out of state for treatment, ie knee replacements, certain seriour conditions. The state of Alaska is looking at this for thier retirees and for employees covered by state insurance.

Am not sure why this was dropped from consideration, but it is an excellent idea, offers better care and saves the University $.

I just read that one option being considered for UAF is to disallow that ability to opt out. I wanted to express that I think this is outrageous-- as helath care costs continue to rise at UAF, families need more options rather than less. To make UAF insurance mandatory when families may have less expensive options through spouses narrows the path that much further. There should be some choices left in healthcare. As the options continue to narrow and healthcare increases outpace the cost of living, we will lose our ability to attract and retain high quality faculty and staff.

I have a n inquiry about one of the proposed changes to the health care plan: waiving the opt out option. Can you clarify what that would mean for those of us for whom both spouses are employed by UAF? When my husband and I talked with our HR reps (years ago now) about whether both of us should enroll in the health care plan the advice we received was a definitive "absolutely not" because, 1) we would be paying for two plans, 2) while having to satisfy two maximum deductible amounts, and 3) we would not be getting double the coverage (as we might if one of us was employed elsewhere with a different health care plan). It was pretty clear that one of us needed to opt out. Needless to say, removing the opt out option would be a major expense and hardship for us, and the many families like us, while providing no benefit.

Further, spouses of UAF employees who work elsewhere would still have the option of opting out of their non-UAF plan, leaving those families with both spouses employed by UAF taking on the largest burden by far.

I understand the reasoning for waiving the opt out option, bringing health plan costs down for everyone, and I support it if it does in fact benefit everyone. However, if this change is being seriously considered, it should not apply to families or married couples with both spouses employed by UAF for whom the benefits would be far outweighed by the financial burder of paying for two plans' worth of fees while receiving single plan coverage.

I am a University of Alaska employee and have used my healthcare benefits very seldom over the 19+ years I have worked for the University of Alaska. You never really understand your health care coverage until you have to use it or begin to stress it. Unfortunately, 2011 was the year that both my husband and I had major health issues that appeared out of the blue and resulted in us discovering just how good our coverage was and wasn't. I have input on three of the issues that apparently are up for consideration:

Remove ability to waive coverage (opt out)

Elimination of the ability to "opt out" could have serious consequences. My husband and I BOTH are University of Alaska employees. He has opted out of his plan and is covered under my plan. In 2011, he developed cancer and went on family medical leave, after he exhausted his family medical leave he was still receiving chemo and radiation treatments and recovering. Had he been on his own plan, he would have been forced into a COBRA situation and we would have lost coverage as not only was he unable to work, had no income for a long period of time until disability kicked in and several human-error hurdles were worked around. My husband would have been required to pay for COBRA coverage which we could not afford.

500 Plan

We (my husband and I) participate in the 500 Plan. If I am willing to pay for the additional coverage, why drop this program? My husband will require major tests to monitor his health, possibly for the rest of his life. There is a huge cost savings for us with this plan. I do not support the elimination of this. One program does NOT fit all.

Health Savings Account

I am Alaska Native. I do not understand the item up for consideration that would not allow me to participate in the HSA if I choose. I am guessing that this is an assumption that being an Alaskan Native, I will not incur a co-pay deductible. I live in Soldotna. Not all my procedures may be covered under Indian Health Care. I cannot always get immediate referrals to ANMC. It is almost impossible to schedule an MRI in a timely fashion if you are outside of Anchorage. There are times that an ER or a trip to a doctor outside of the Indian Health Care program will result in my paying a co-pay. Not all procedures I might desire are available (or desirable) through Indian Health Care and I should not be penalized for having access to this coverage.

I am one of the 500 employees that chose to "opt out" of the UA health plan this year. I have coverage through my spouse which is significantly more affordable than the new UA plan. I am very concerned about the possibility that employees will no longer have the option of waiving health care coverage. After seeing the high deductible plan go up from approximately $1,000 to $3,000 in one year, I have very little hope that the costs will not continue to increase significantly in the coming years. This is simply not affordable for many of the employees at UA, especially staff who are on the lower end of the pay scale.

I strongly oppose a recommendation to take away the "opt out" option for UA employees.

A question has just come up about being able to do an FSA for child care and an HSA for health care. Would this be possible? The letter states that people have to choose between the two plans but cannot take both; I read that to mean the 2 health plans.

Answer:The FSA for child care is totally separate from health care, so yes you could do that. You can't have any other plan that would pay "first dollar coverage" for health care, other than preventive care as allowed in the regulations.

Consideration of not allowing HSA and FSA together doesn't follow typical setup of the plans.Typically (as seen in the industry), employees with HSA are allowed to have FSA with limited use like Dental and Vision only.It would be good and smart move to consider that option since even basic costs of dental health here in Alaska are barely covered by the dental plan provided by the university.IRS currently doesn't have restrictions on having FSA and HSA plans together aside from use restrictions.

I suppose health care benefit pricing plans and options inevitably grab attention, but it does seem that critical life and death issues for employees are overshadowed by all the attention on financial options and details. Whatever the headlines or the fine print seem to say about health care, our UA benefits seem to be rigged so that much medically useful or necessary care is not covered. In just my own case, preventive care involving accurate tests, treatments, and care have all been denied entirely, leaving me to pay 100% of costs (without counting against deductibles!) or forego care risking future more serious - even life threatening - conditions.

Of course as part of the University's "business side" it appears that a key mission in administering health care benefits is reducing University outlays. There appears to be little incentive either to reduce employee costs of care or to actually maintain long-term health. That's not to impugn the professionalism of the staff responsible but rather to note that the financial administration of benefits needs counter balancing with advocacy for appropriate medically advisable employee health care. Can Staff Council and/or the Staff Health Care Committee perform that vital function? I hope so!

I just perused the “considerations” as listed in the FY14 Health Care Design Plan Considerations document and am EXTREMELY concerned about Point/Item #1. As stated, it reads: “Remove the ability to waive coverage (opt out). This would bring about 500 employees back on the plan and recover anywhere between $217,000 - $600,000 in health care charges paid by employees, depending on their plan and dependent enrollment.”

Due to excessive monthly premium, out-of-pocket, co-pay (and others) hikes in health care costs directly linked to the UA system Plan, I personally opted out of coverage through the university system over a year ago. I am covered, instead, through my spouse with the Anchorage School District (ASD).

The Plan, as I remember and know it still to be, includes VERY poor levels of coverage for employees when simply visiting a doctor, much less having a surgical procedure done, etc., especially when compared to what the noted ASD healthcare coverage policy entails. Hence, my rationale for switching Plans also was reflective of the other ‘pieces’ of the UA healthcare Plan that so many thousands of us had/have to deal with each and every time that we go/went to the doctor or had ANY sort of medical item that came up that we addressed. In so many respects, the ONLY way that the university Plan even comes close to start being (financially) beneficial is if it is USED almost to the point of being excessive..the out-of-pockets being almost ‘maxed out…each and every fiscal year (FY). This, in short, is simply TOO EXPENSIVE to do, especially for single parents and those of us with families.

Further, new federal law(s) require coverage for individuals, which I have and can provide proof of. Regardless of potential savings to those on the Plan on an annual basis, I cannot imagine that forcing someone to into a ‘double-coverage’ situation—which I would be because ASD’s Plan is FAR better than UA’s at present—will/would stand up if challenged in either State or Federal Court. ANY amount of litigation—even if it never reaches the Court level—would undoubtedly cost the UA system thousands upon thousands of those perceived ‘savings dollars’ being expended unnecessarily. Concisely, I MEET the new federal requirement for full health insurance coverage, and without question, I, for one, will/would challenge—legally, if necessary—ANY requirement on the part of the university system for me to ‘opt back in’ to their sub-standard healthcare coverage Plan. The ONLY way around this might be—and as a gentle suggestion for the Committee—for a ‘Grandfather Clause’ of some sort to be built in for those of us already employed by the UA system in some capacity and, in tandem, also no longer receiving health insurance through the UA Plan system.

1. I think we need to establish why employees are opting out of the health care plan before we eliminate that option. If they are opting out because the deductible is too high, the sensible solution would be to lower the deductible to a more reasonable level. 2. I'm concerned about the spiraling rise of the deductible. Eventually, out of pocket costs will reach a point where it is just like not having insurance at all. I realize that the university is trying to push more costs onto the employees, but that strategy presumes that the employees have adequate sums of money which is not the case. 3. HR needs to adopt software which will automatically go through and notify employees when their kids have aged out of health care coverage. As I'm sure you'll remember, Joann has had to repeatedly contact HR in an effort to get son taken off their insurance in October. In other places where she's worked, that's done automatically. I don't know why HR hasn't adopted this procedure already, but they definitely seem to lag behind in streamlining their operations.

The University is putting a ban-aide on the issue. We need to unite with other Alaskan agencies like the State and tell congress that 10,000+ voters will not approve the Government health care being proposed by Congress.

First, removing the 500 plan is an excellent idea - I did an analysis 2 years ago and discovered that in a practical sense, it NEVER is a better deal than other 2 plans. I felt that we were stealing from our employees.

Second, I don't believe we can force people to join our plan unless one of two conditions apply:

The person is not covered by another plan OR The University covers the premium for employees at 100%

If they are not covered elsewhere, forcing them to take our policy is feasible.

Third, I am not a benefits analyst, however, it seems like it would behoove us to have people pay a higher premium - not just pay larger deductables. I could be completely wrong here...maybe we make it up on the deductable...but looking for a way to use economics to drive people toward the middle plan may make sense (although I have heard there are tax implications to this in the future).

Finally, the family with more children tier seems painful. Chances are those families have a single income (the employee here). Is it really that much more money? The bad feelings surrounding that, even from those of us without 4 children, would be very expensive.

I wanted to comment on the FY14 Health Care Design Plan Considerations that were provide to UA employees this morning. I can only comment to number 1) Removing the ability to waive coverage (opt-out). I am STRONGLY opposed to this consideration! If an employee has other health care and provide proof of health care they should not be forced to pay for additional care. I feel it would be extremely unfair and an additional financial obligation to force employees covered by other health care plan(s) to pay for care they will not necessarily use and currently have not chosen.

I choose to opt-out two years ago due to the increase costs of the health care plan that UA offers. My particular circumstance I have retired Military health care and health care through my spouse who is employed by the State of Alaska. My family already pays for two health care plans that meet our families needs. I should not have to pay for another plan I don't want or need to "recover anywhere between $217,000 - $600,000 in health care charges paid by employees".

The first item is the one that irritates me the most. I have health insurance...I don't really like the idea of being made to "opt in" to something I don't need. However, if we 500 have to opt into it...we will certainly use it, so what will be

the ratio of "recovered" money to the output of claims by those 500. I can tell you in my case alone there will be close to $100K a year (for my husband). Those with Tricare won't have any choice but to use the UA plan;Tricare will force them to. Also, I believe this has been considered before and found non-cost effective.

I thank you for sharing the Health Care Design Plan considerations with staff at this stage of their development.

I am unfamiliar with the process the University uses when receiving decisions from the Staff Health Care Committee. Will final decisions from the Staff Health Care Committee be implemented by the University Benefits system?

Regarding the first point, removing the ability to waive coverage or opt out. I'd like some rationale for this consideration.

A few fortunate employees may already have necessary insurance coverage, including Military and Alaska Native employees. Why should these groups of employees be burdened with the cost of insurance from the University if they already have adequate coverage?

I'd suggest requiring employees to demonstrate they have coverage available elsewhere in order to opt out. A past employer implemented the inability to waive coverage unless they signed a form stating they had insurance elsewhere.

Asking employees who already have insurance or access to better insurance should not have to endure this expense. I'm surprised a group composed of staff would choose this option. This sort of policy is usually pushed down from the top, how surprising.

Dropping the ability for someone to waive a plan that is unnecessary and seems ridiculous. Although it will forcefully bring people back into the plan (500 may be low as a percentage of employees on the plan - it would be nice to know total %), it also increases overall plan costs and exacerbates an already increasing problem. Its equivalent to taking more classes in order to avoid paying student loans...it only adds to the loan later!

#1: I'm opposed to prohibiting employees from opting out of UA coverage for the reason that it has gotten very expensive and the employee share is bound to continue to rise. #2: Yes drop the 500 plan--few will be able to afford it. #3: Why not implement a surcharge per child; employees pay extra for a spouse or dependent partner, so why not per other dependent? Thanks for the opportunity for feedback.

I would like to express that option 1, requiring all employees to opt-in to the UA health plans, seems like a real disservice to employees. I can imagine that, if I was able to get better coverage elsewhere, I should be allowed to do so without keeping the coverage with UA. This is also ironic in that the change could backfire and end up costing UA more with more claims.

I would be very disappointed to see the “waive coverage” option removed. I understand that health care costs are rising, but to make people who do not use the service make up the shortfall is underhanded and opportunistic at best. My family is already paying for a family medical plan elsewhere so I definitely don’t want to have to pay for the same coverage twice.

I have not opted out but I think it's extremely unfair to remove that option IF you have other coverage (which I think is already the condition for opting out). The way insurances calculate coverage it's generally NOT financially smart to have two health insurances if you pay for them. Better to purchase better coverage under ONE policy. Otherwise you pay twice as much but you DEFINITELY do not get double the coverage. I'm in that rare case where I could have THREE insurance policies(My UA one, one from my wife's retirement coverage and another from her current place of employment. We opted out of the third as it would not benefit us in the least. As others have pointed out, having more people filing claims is probably not going to save the University money.

I probably agree with having a tiered portion for those with children (I have children). While it helps those families, it's really hard to justify someone with 8 children paying the same amount of someone with 1 or 2 while likely putting in far more claims on the system. That's definitely an unfair load on the system. I've thought about that years ago as others have also said.

Comments relating to the list:1. KEEP the OPT out option. No need to force individuals to pay more for health care.2. YES, drop the 500 Plan.3. YES, pay more for more people in the family! Of course. At the same time, pay less if you are a single adult.4. No comment.

Comments by me:1. Please drop the Best doctors program because it doesn't provide any useful or different information than I can get myself by searching.

2. Incentive Programs with local exercise facilities (i.e.) offset the cost of gym membership at a a facility of my choice.

3. Provide a real resource list (Similar to this blog) of hospitals overseas or in the L48 that provide surgeries and other medical procedures for less, and request that employees who have utilized those institutions comment on their experience.

4. Number 3 can be key in cutting cost. I really wish you would put more energy in this area. Health care won't get cheaper in the U.S. but it is cheaper everywhere else. Get on with looking at these other resources!

Suggestions:What about allowing us to use the clinics available to students on campus? This would cut cost for the employees.

Look at an option that would put the Flexible Spending Account (FSA) money on a VISA/Mastercard. The amount of money that the employee requested on their FSA form would be available on July 1. This would reduce the amount of upfront cash that employees have to spend on deductibles. Many employees never go to the doctor when they are sick because they can't afford the cost of the appointment.

I would be nice if there was a copay for doctor visits instead of having to pay the full amount until deductibles are met.

I think that is a very good idea, and much more fair. I have quite a few children who I can and do put on the plan, and it doesn't seem fair for me to pay the same as someone who is putting only one child one.

Has anyone looked into merging with the school district's health provider? My understanding is that the only reason we cannot do this is that technically UA employees are not designated as state employees like employees in the district. It seems this would only take political will to change the appropriate documents. This would benefit all- the employees with lower rates and the insurance co. with more paying customers.

I do not think that removing the "Opt Out" option is a good choice. This could have affects on trying to hire new employees. Plus, people deserve the right to choose the best coverage that is available to them. If they are already covered through a spouse, they should not be forced to take insurance from UAF.

I have read the blogsite under #4. I just don't see this as being a good option.

There are a lot of reasons to let employees opt out - many have better and less expensive coverage through other means. Having a HSA option is fine, as long as it is not the only option. Many are not allowed to use a HSA with other coverage they have. We should not force this on those who have no choice about it.

Our coverage is not near as good as it used to be. Several changes over the last few years have made it so. Our vision coverage through VSP is abysmal. I tried the so-called VSP preferred providers and found them to be very lacking. My usual eye doc is not on the preferred list, so I tried one that was – at the time VSP would only cover $45 of a non-preferred visit, which would have made me pay $125 out of pocket for seeing my own doc. Instead I ended up having to pay $300. While the eye exam was covered with only a $10 co-pay, I was sent to another eye clinic for photos and a peripheral sight test. Those tests cost $800 – and $300 was not covered, even though it was due to seen abnormalities. Blue Cross, not VSP, covered this part as it was ‘medical tests’. However, had I seen my usual eye doc, she does those tests all at her own clinic and its included in the cost of a routine exam! So, due to trying to force our employees to see providers on the ‘preferred list’, the plan ended up paying $500 more and I had to pay $300 more than if I had seen my usual doc. Needless to say, my next visit was to my eye doc of choice, and I saved a lot of funds and got a much more comprehensive exam.

Our pharmacy benefits are also not near as good as they should be. We have all these messages and pushing to get healthier, Win for Alaska, Alere and such – that our plan pushes to help people get healthier and keep those with chronic issues on a plan. However, we don’t get help when it comes to the drugs they need or testing supplies. Diabetes testing supplies will never be generic, there are NO generic lancets or test strips – since each meter is branded and can only take that brands test strips, and the punch device can only hold that brand lancets – so each of those costs at the branded price. This becomes very expensive and I know there are those who don’t test as they should in order to save supplies and not have to pay as much. Also, I know there are those not getting the medications they really need to treat their issues as they can’t afford the cost for the branded medications that will actually treat them, and end up using a different medication than they really need because it has a generic they can afford. $50 - $100 more a month might not seem like much, but add that up over a year and it becomes quite a bit and makes a large difference for many people.

So far our plan is not fairing well - and this doesn’t include the many issues with our dental coverage.

I finally had to choose to opt out this year. The cost of our plan had such an extreme increase I really had no choice. I simply can’t afford the UA health plan any longer. Using our plan over my spouses plan will be giving me a pay cut of more than $4000 a year – with the 26 pay deductions (currently about $57 for the HDHP), the $1250 current deductible and the extra cost for prescriptions, it adds up very quickly to an extreme amount for me. And I fully expect the cost for employees to go up again next year and it will cost even more.

Thank you for all the hard work you are putting into the health care issues on campus.

While I like the idea of our costing going down my requiring staff to be a part of the plan; I think it is unethical. You can not require people to be a part of our plan; bottom like it is unethical and participation should not be mandated.

Increase for families... it's about time! If you choose to have many children, that is YOUR choice... not my, or my families responsibility to financially cover you. This is a huge injustice and families with more than 3 children must pay per child/member.

Improvements you make the HD plan would be great. I am enrolled in it, but still do not have money to go to the doctor. I've been dragging my sick butt to work because I can't afford going to dr office.

I have not read all the comments so apologies if someone else has already suggested this. The last time I had an annual check up it was ovr $250! I would recommend that important yearly screenings be offered FREE or for a very nominal fee to the employee. I would suggest making this available for free or cheap whether or not a person has met their deductible. In my own case, my high deductible (I earn slightly more than $30K year after taxes)definitely discourages me from taking care of my annual pap test or annual check up because it's so expensive. What incentive do I have to get a check up when the (rising) costs come from my own pocket and I make so little money to start with? Yet, what better and easier way to catch incipient problems like cancer? Will I skip my pap test a year or two because it's so expensive? Or should UA support preventative care by ensuring that it stays affordable? Catching cancer or heart disease early is the very best way for UA to save on health care costs. Catching even one cancer early will save tens of thousands of dollars later.

I am fully covered under my spouse's health insurance through the State of Alaska employees' health system. Why should MY employer require me to be doubly covered, paying additional costs out of my 9 month, 30 hours a week contract pay? The additional costs for health coverage (that I already have and pay for) are prohibitive based on my salary. I should not be part of a plan to spread the cost when I already have health coverage and this additional coverage will reduce my take home pay, families are not under a tier system based on number of family members, and my paycheck will noticeably decrease for a cost I should NOT be required to assume. I have excellent health coverage through the State of Alaska already; why do I have to have additional, redundant coverage?

I want to make these comments. First, the forums were held at the Wood Center on the (18 Jan) first day of the Spring Semester, Why? Many, many people including myself could not attend due to students/faculty returning.I wanted to "voice" my comments.

Second, My comment deals with the Opt Out. I am a 20y US Army disabled veteran (retired), I receive VA health care. That is why I opted out. Why should I pay for health care with the UA if I will never use it? My husband is a 20y US Army disabled veteran (retired). Due to the union at his state job he has no choice but to have to pay minimum healthcare. Why? For that I know you nor anyone else can (or has) explained that. The state gets free money from us due to the union rules that were in place prior to him being hired.Having said all that, now if I want to go under his union healthcare (which I do not need) I have to pay a fee to do that? What the heck?

Anyway, so Why should I have to pay health care with the UA or the his state union? Times are hard enough.

Can someone give me a very good reason why I should have to pay? I should be able to Opt out with out being penalized, since I am covered by the government.I am not asking for "special" treatment, just an answer of why?